Steps To Follow For An Easy Health Insurance Claim Settlement

by Admin ~ October 23rd 2018

Medical expenses can prove a headache for the patient and their loved ones if not managed properly and insurers are making a way for the same. Different health insurance plans are being introduced to provide customers with a wide range of options to choose from. Companies are known for offering great cover and benefits to attract more customers. However, getting a claim is not an easy job for many and might takes time longer than usual. In this blog, we are going to talk about the steps needed for an easy claim settlement.

Types of Claim Settlement

Basically, there are two ways of settling a cheap health insurance claim and we are going to explain both of term here. One can go for a cashless option where they send the medical bills to the provider and they pay the same. Another option is reimbursement where they insured pays the medical bills and the insurer provides pays to them later.

  • Cashless Claims

    Most of the providers offer the cashless claim option to the insured and is being much popular among them where they don’t need to pay anything to receive the required treatment. Let’s get to know the steps to receive a claim easily.

    1. Step 1. First of all, you are supposed to look for two things. You should check whether your disease is covered in the plan offered. Also, you are supposed to confirm whether the hospital or clinic in your insurance provider’s network.

    2. Step 2.Whenever going for an admission in the hospital, you are supposed to fill a Pre-Authorization Form to inform the insurer about the same. You will need to submit the duly filled form at the TPA (Third Party Administration) counter and will be further sent to the provider for their approval.

    3. Step 3. You are required to submit the relevant documents to the insurance providers that include Cashless Heath Card provided by the insurer and KYC documents for identification.

    4. Step 4. Once you get cashless approval from the provider, you will have to submit original papers and bills to them. Hence, you are advised to keep a copy of them for your own records.

  • Reimbursement Claims

    Some health insurance quotes don’t come with the cashless option and the insurers reimburse the medical bills later. The insured needs to pay their bills first and then claim for a reimbursement for the amount spent. Let’s get to know how it’s done.

    1. Step 1. You are supposed to inform your provider within 30 days of being discharged from the hospital and fill a reimbursement form for the same.

    2. Step 2.You are supposed to submit all the relevant documents that include medical reports, medical bills, and hospital bills. You will have to submit the original copies of these bills and the forms should be duly stamped and signed. Also, the documents should clearly show the registration number of the hospital, name of patients and other details.

    3. Step 3. Also, the insurer may ask for the Discharge Summary/Card provided from the hospital or clinic where you received the treatment.

    4. Step 4. They may also ask for the doctor’s follow-up prescription after discharge, and the claim is supposed to be settled within 2 or 3 weeks on submission.

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